Henoch-Schonlein Purpura

Sign-up for DrGreene's Newsletter

About once a month we send updates with most popular content, childrens' health alerts and other information about raising healthy children. We will not share your email address and never spam.

Email Address

My neighbors’ 9-year-old daughter was recently diagnosed with a condition called Henoch-Schonlein purpura. This apparently followed a viral infection. She is under the care of a physician and this was diagnosed by a biopsy. I have done several searches “on line” and have not come up with any information. Would you be able to shed some light on this subject or steer me in the right direction as far as resources? What is the cause of this; implications – long term?
A Registered Nurse – Froedtert Memorial Lutheran Hospital – Milwaukee, Wisconsin

Dr. Greene’s Answer:

No one knows what causes it. We do know that it often follows a viral respiratory infection. It seems to be some kind of allergic reaction to the virus. It has also been seen following Strep throat, prescription medicines, bee stings, chemical toxins, cold exposure, and food allergies. It can occur in epidemics. In the Northern Hemisphere it occurs most commonly between November and February. It is often accompanied by a low-grade fever, and just not feeling well. It most often affects children ages 2through 10, boys more often than girls. The older the child (or adult), the more likely it is to be serious. We know that it can be life-threatening, but that most children recover. “It” is Henoch-Schonlein purpura (HSP).

HSP is a type of vasculitis — an inflammation of blood vessels — that was named for Drs. Henoch and Schonlein, who each discovered it independently more than 30 years after it was discovered by Dr. Heberden, who got no credit.

Tiny blood vessels in the skin swell and then hemorrhage, giving rise to the characteristic rash of HSP. The rash usually begins with small hives, or red patches, or red bumps, which can appear anywhere on the body, but especially on the legs and buttocks. This rash represents swollen blood vessels, and the spots blanch with pressure, since pressure moves the blood along the vessel. The allergic nature of the rash often makes it itch. As time passes, blood leaks from the swollen vessels, the rash changes from red to a bruised, purple color (hence the name purpura), and the rash no longer blanches when pressed. As the tiny bruises heal they turn to a rust color, and then fade. Each spot lasts for about five days. Often the rash comes in several crops, and a single child may have a rash of a variety of different colors. All children with HSP have the skin rash (by definition). The rash resolves without trace. (“A savvy mom named Beth Anderson wrote and suggested that when her son had HSP, “the term “blood blisters” was the key to describing the rash for those who couldn’t see it in person. Most people have had a blood blister and can relate to the term better than bruises.”)

The skin rash is the most obvious, and most common, finding in HSP — but by no means the most serious. Blood vessels in other parts of the body can also be involved –most frequently in the joints, the intestines, and the kidneys. Rarely, vessels in the muscles, eyes, testicles, lungs, heart, and brain have become inflamed, sometimes leading to serious consequences.

Joint involvement occurs in two thirds of the children. The knees and ankles, particularly, often become swollen, tender, and painful with movement. This arthritis can be quite debilitating, but usually resolves in just a few days. No permanent deformity results, even with the most severe arthritis.

Inflammation of the blood vessels of the GI tract occurs in more than half of the children. Most of these experience abdominal pain, often quite severe. They will often vomit — sometimes vomiting blood. More than half of the children with HSP will have bloody stools. Serious short-term complications most often come from the GI involvement, some of which require observation in the hospital and some require surgery.

Kidney involvement affects between one-fourth and one-half of the children with HSP. They may have blood and/or protein in the urine. They may even have kidney failure. Serious long-term complications most often come from the kidney involvement.

Full-blown HSP may appear suddenly, or different symptoms may appear gradually over several weeks. The order in which the symptoms appear varies. A child might have unexplained abdominal pain, or knee pain, or bloody stools, or blood in the urine for a week before other symptoms appear to bring the correct diagnosis into focus. The diagnosis is usually made when the rash turns purple.

Most children recover fully. The disease may be quite mild and last only 2 or 3 days. For those with moderate to severe symptoms, though, the disease is usually gone within a month. Two-thirds will never have a relapse. For those who do, it is usually within the first four months particularly after the child gets another cold or is re-exposed to the offending agent. Thankfully, the relapses usually are both milder and shorter than the original episode.

Rarely, children die from complications experienced near the time of diagnosis (bowel perforation, hemorrhage, seizure, stroke, etc.). Having made it through the acute crisis, the long-term outcome depends on the extent of kidney involvement. With no kidney involvement, full recovery is the rule. One-fourth of the children with kidney problems will still have detectable problems years later. By 8 years after onset, however, only 2% will still have any kidney problems. The long-term prognosis can often be determined from a renal biopsy early on.

There is no specific treatment for HSP. If the initiating trigger is identified for an individual child, everything possible should be done to remove it. If the cause is thought to be a bacterial infection, such as Strep throat, prophylactic antibiotics are often given once the infection is eliminated, to prevent recurrence. Anti-inflammatory drugs, and sometimes immunosuppresive drugs, are used to provide much-needed symptomatic relief. Steroids are controversial – they may cause dramatic reversal of GI or brain involvement, but have not been shown to be very effective for the kidneys.

. HSP is a very serious disease. Thankfully, it is also very uncommon. The odds are that your dear little friend will recover from this with nothing to show for it except some bad memories.

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

22 Comments

Arti

Hello,
My son had FLU with cold and congestion in December and after that in January I saw a small rash near his top eyelid. Slowly the rash spreaded on both the eyes, and is there since then. It has been 4 months and I still see the black rash around his eyes shattered. Not sure if this is HSP. I took him to ENT specialist where she did is scan which showed his sinuses are fine. I also showed it to our pediatritian and she does not know what it can be. She referred us to a dermatologist by saying that it looks like a rash ruling out the possibility of lack of sleep or sinus infection.
If anyone has experienced similar or knows about something similar please respond.

Added:
April 21, 2015

Elissa S.

Hi Dr. Greene,
I was diagnosed at 2yrs old with HSP. My case was severe and required surgical removal of a section of my intestines. I am now 43, and I have a list of health issues that seem to stem from my HSP. I was wondering if you could recommend some resources where I might find more information on long term/life long effects of HSP. All the research I have found says doctors do not really know of long term effects except renal issues, but I am pretty sure I can connect all my health issues to the damage of my HSP. Any suggestions of where to look or even a specialist that might handle HSP cases? I would really appreciate any information you could give me.
Thank you,
Elissa

Added:
April 10, 2015

wendy smith

Added:
June 24, 2015

Maureen

My daughter, 13, was diagnosed with HSP on Feb. 3rd. Previous to that, she had the flu and a respiratory infection and was given an antibiotic. The rash showed up first on her palms. They were like little cuts covering the whole palm on both hands. Later that day, her legs, ankles and butt were covered as well. It kept coming and coming. The rash on her legs lasted about 2 weeks, with just a handful here and there on her legs and ankles. The rash on her hands still come and go.

In addition to the rash, she had severe joint pain in her knees, ankles, elbows, and hip, as well as nausea, headaches and abdominal pain. The joint pain is better but she does still experience it frequently in her knees and ankles mostly. She is still having headaches too. Nausea is the biggest complaint now. It’s been two months and she is still miserable. She hasn’t done a full day of school for over two months. At this point, the rash keeps showing up in her hands and it bothers her to hold a pencil!

I feel awful for her and wish I could help her. Ibuprofen and Tylenol does not help but she does sometimes get some relief from Alleve. Sometimes I wonder if a lot of it is nerves or her reacting to the stress of it. If I mention this, she thinks that I think she’s faking. I know she’s frustrated. I’m frustrated too. The nurses at her school are losing patience with her showing up there every day even though we have a doctor’s note. They don’t get it. When is this going to go away??

Added:
June 24, 2015

corrie

My son has HSP. He got small blisters on his hands and they swelled up. His rash begins as what looks like bug bites and they itch. Then it begins to look more like what they describe the HSP rash to look like. He’s had it for 6 weeks now. For three weeks he couldn’t walk bc his joint pain was so severe.

Added:
February 20, 2015

Jacques

I have HSP and its going on more than 2 years now. I only take Dapsone as prescribed by my doctors. I have done many, many tests and nothing else internally (organs) have been affected, although I do have occasional severe joint pains. The doctors have assured me that the disease after all this time will basically stay with my skin and not affect any organs. If I stop taking my dapsone, I flare up within 2-3 days. I feel like the meds are only hiding the illness and I will run into severe health problems one day. I am 52 years old.

Added:
February 11, 2015

sandra brooker

Hi my 4 and a half year old has HSP. He had the rash and spots and more spots and rashes. It seem to appear more on him on a daily basis. Can you tell me if this is right? His name is Anthony and I love him dearly.

Added:
December 26, 2014

E. Low

Added:
December 17, 2013

Al Martia

I’m an adult (40) who had HSP 6 months ago; it went away any never came back. My doctor ses to think I was allergic to an antibiotic (ciproflaxin?) that I was taking for a chest cold. The HSP didn’t occur until I took that medicine.
My question is, will I have a recurrence if I get another cold? or should I be ok as long as I stay away from that family of antibiotics? I’ve had every blood test under the sun for the past 6 months and I was told my blood is “stable” and within normal range. I’m scard to get a cold thinking that this will be the norm every time.

Added:
August 26, 2013

Kristen

I also had HSP after taking an antibiotic, as a child, and again as a teen. Then in my 30’s I took a different antibiotic and had it again! I do not get recurrence when ill, just when I take certain antibiotic meds.

Added:
March 26, 2015

wendy smith

Hi, It is normal to monitor the blood after hsp. I’d be inclined to keep a record of your health. You can never say when it might flare up. Each case is different. However, its always worth while keeping a close eye on things including fatigue, joint pain, urine problems, etc.

Added:
June 24, 2015

candybowman90@gmail.com

My 8 year old daughter got HSP August 2012. She has already went into complete renal failure. She is on dialysis 3 times a week which they started a week ago. The doctors say she is not a candidate for a transplant until the HSP stops. Be honest with me pleader.. what are her chances is surviving this.

Added:
May 14, 2013

sue

Added:
May 14, 2013

elise beer

hey I had this when I was I child is there any long term problems that come out later in life. as an adult. I am having some interal problems. and just want to now if this can be a reselt of having hsp as a kid

Added:
April 9, 2013

hey elise! when it comes to long term problems from HSP, the big one we know about is kidney problems. As I said in the article, somewhere between 25%-50% or so of the people with HSP have kidney problems in the short term. Of these, most do not have long term problems, but some do, years later as an adult, even after having recovered fully in between. Apart from kidney problems, though, I’m not aware of other proven internal issues later as an adult. All my best in sorting out what is going on!

Added:
April 9, 2013

elise beer

Added:
April 9, 2013

Elissa S.

Hi Elise, my name is Elissa and I had HSP when I was 2yrs old, I’m now 43. I found your post while looking for answers to certain health issues I have that seem to lead back to my HSP. My case was severe and I had to have surgery to remove a section of intestines. Since childhood, EVERY time I eat, I am in the restroom within 10 minutes. I have been diagnosed with malabsorption issues, CHF, iron, vitaminD and B12 deficiencies among other issues. I have had a VERY difficult time finding any information on long term/life long effects of HSP, but am desperately looking for answers! Would love to compare notes with someone who may have some of the same issues I have experienced. If you would be interested please let me know and maybe we can chat by email or how ever you might be comfortable doing so. I hope you find the answers you are looking for, and know that you are not alone in your search for answers.
Best Wishes,
Elissa

Added:
April 16, 2015

Charlotte

Hi my son 5 years was diagnosed with hsp August 2014. Although the swelling and rash have gone, (ended up Jin a wheelchair for a few weeks) he still has days where he limps or is uncomfortable, 10 months on. I think the research needs to be redone as they say it usually goes away in a couple of months.